Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

BACKGROUND: We evaluated the value of neutrophil-lymphocyte count ratio (NLCR) in patients admitted to the Emergency Department (ED) with suspected nursing home acquired pneumonia (NHAP). METHODS: From May 2011 to January 2013, 116 patients admitted to the ED with suspected NHAP were retrospectively studied. The clinical characteristics, C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, and NLCR were assessed. CURB-65 score was used to calculate disease severity. General ward or intensive care unit (ICU) admissions, and 72-hour and 30-day mortality for each infection marker was assessed. RESULTS: The 116 patients had a median age of 77 years. As the CURB-65 score increased from 0-1 (low risk), to 2-3 (moderate risk), and to 4-5 (high risk), the NLCR consistently increased (mean, 6.9, 8.89, and 16.22, respectively). The difference between the moderate and high risk groups was significant (p=0.008). The NLCR (mean+/-standard deviation) was high in patients with NHAP (10.28+/-8.81) and increased even more for patients admitted to the ICU (15.69+/-14.81) or who died within 72-hour (15.63+/-9.57). NLCR showed the trend of higher value in ICU admission (p=0.072), and CRP was significantly different between ICU and general ward admission (p=0.007). CONCLUSION: NLCR at ED admission correlated with NHAP severity and was comparable to the traditional infection marker. NLCR can be assessed simply and added to the assessment tools to determine the severity of pneumonia during ED admission.
C-Reactive Protein ; Emergencies ; Humans ; Intensive Care Units ; Leukocyte Count ; Lymphocyte Count ; Mortality ; Neutrophils ; Nursing Homes* ; Nursing* ; Patients' Rooms ; Pneumonia* ; Retrospective Studies

PURPOSE: A pep27 mutant may be able to elicit mucosal immunity against pneumococcal diseases, and could be employed as an inexpensive attenuated vaccine. However, this particular mutant contains an erythromycin-resistance marker. The purpose of the current study is to develop a markerless pep27 mutant and assess whether this inactivated mutant is able to induce mucosal immunity. MATERIALS AND METHODS: Mice were vaccinated intranasally with the inactivated markerless pep27 mutant every 2 weeks for a total of three times, after which time serum samples were analyzed for antibody titers. The mice were then challenged with a lethal D39 strain and their survival time was measured. The cross-reactivity of the antisera against pep27 was also compared to other mutant serotypes. RESULTS: Intranasal immunization of mice with the inactivated markerless pep27 mutant provides effective protection and rapidly cleared bacterial colonization in vivo. Moreover, antisera raised against the pep27 mutant may cross-react with several other serotype strains. CONCLUSION: Intranasal immunization with the inactivated pep27 mutant may be able to provide mucosal immunity, and could represent an efficient mucosal vaccine.
Animals ; Colon ; Immune Sera ; Immunity, Mucosal ; Immunization ; Mice ; Sprains and Strains ; Streptococcus pneumoniae

OBJECTIVES: The aim of this study was to investigate whether a medium to high degree of total physical activity and indoor physical activity were associated with reduced all-cause and cardiovascular mortality among elderly Korean women. METHODS: A prospective cohort study was done to evaluate the association between physical activity and mortality. The cohort was made up of elderly (> or =65 years of age) subjects. Baseline information was collected with a self-administered questionnaire and linked to death certificates retrieved from a database. Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence interval (CI) levels. RESULTS: Women who did not suffer from stroke, cancer, or ischemic heart disease were followed for a median of 8 years (n=5079). A total of 1798 all-cause deaths were recorded, of which 607 (33.8%) were due to cardiovascular disease. The group with the highest level of total physical activity and indoor physical activity was significantly associated to a reduced all-cause mortality (HR, 0.60; 95% CI, 0.51 to 0.71 and HR, 0.58; 95% CI, 0.50 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. Additionally, the group with the highest level of total physical activity and indoor physical activity was significantly associated to a lower cardiovascular disease mortality (HR, 0.53; 95% CI, 0.40 to 0.71 and HR, 0.51; 95% CI, 0.39 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. CONCLUSIONS: Our study showed that regular indoor physical activity among elderly Korean women has healthy benefits.
Aged ; Aged, 80 and over ; Cardiovascular Diseases/*mortality ; *Cause of Death ; Cohort Studies ; Death Certificates ; Exercise/*physiology ; Female ; Follow-Up Studies ; Humans ; Korea ; Proportional Hazards Models ; Prospective Studies ; Risk Factors

PURPOSE: To establish new in vitro model systems that better reflect in vivo condition, multicellular tumor spheroids(MTS) and raft culture were developed using cell lines of squamous cell carcinoma(SCCHN) of the head and neck. In these 3-dimensional systems, the expression of cell surface molecules which are important for modulation of physiology of tumor cells were studied with or without the treatment of interferon(IFN)-gamma. MATERIALS AND METHODS: Four SCCHN cell lines were used for MTS and raft culture. The effects of interferon-gamma on SCCHN cells were examined by immunohistochemistry. RESULTS: All cell lines formed MTS, but only Tu-138 showed a good stratification at the air-liquid interface in the raft culture system. Immunohistochemical studies of MTS using monoclonal antibodies revealed a strong staining for MHC class I, no staining for MHC-DR, a weak patch expression of ICAM-1 and a central strong staining for integrin a 6. Staining patterns were similar for the raft cultures except integrin a 6(intense full-thickness positivity). In both systems, IFN-gamma enhanced the expression of MHC-DR and ICAM-1. No significant change was found in the expression of MHC class I and integrin a 6. CONCLUSIONS: MTS and raft culture system were established successfully from the SCCHN cell lines. IFN-gamma can modulate the surface molecules of tumor cells in the 3-dimensional culture systems.
Antibodies, Monoclonal ; Carcinoma, Squamous Cell* ; Cell Line ; Head* ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Interferon-gamma ; Neck* ; Physiology

OBJECTIVE: The authors report a case of racemose neurocysticercosis presented with myelopathy and hydrocephalus. The cllinical symtoms were not relieved even after the operations with albendazole medication. METHODS: A 44 year-old man was transferred due to headache, quadriparesis and epileptic fit. Preoperative magnetic resonance image(MRI) on brain and computed tomographic cisternogram on brain and upper cervical cord showed racemose cysticercosis on vermis, medulla and upper cervical cord. Two times operations(vesicles removal and adhesiolysis on cerebrospinal fluid pathway) were done with albendazole medication(15mg/kg/day, 30 days). The clinical symtoms were not relieved. Ventriculoperitoneal(V-P) shunt procedure was done and the symtoms were improved. CONCLUSION: The cause of aggravated hydrocephalus might be inflammatory reaction of the host to acute destruction of parasites due to albendazole in the brain.
Adult ; Albendazole ; Brain ; Cerebrospinal Fluid ; Cysticercosis ; Headache ; Humans ; Hydrocephalus* ; Neurocysticercosis* ; Parasites ; Quadriplegia ; Spinal Cord Diseases*

OBJECTIVE: To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. METHODS: The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients (2.9%) who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively (mean, 13.47 months). The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels(L4-5 and L5-S1) in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery was defined according to Gleave and Macfarlane7). RESULTS: In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients(93%) with regaining urinary continence. Thirteen of 15 patients(86%) with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. CONCLUSION: In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.
Anesthesia ; Cauda Equina* ; Decompression ; Diskectomy ; Humans ; Hypesthesia ; Laminectomy ; Lower Extremity ; Polyradiculopathy* ; Recovery of Function ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence

Object : This study was conducted to evaluate the surgical results of the active treatment of unruptured intracranial aneurysms (UIAs) and to suggest treatment indications. METHODS: Operations were performed on 49 patients with 52 UIAs between 1999 and 2005. Medical records and radiologic studies of the patients with UIAs were retrospectively reviewed. The clinical outcomes were evaluated in each patient by the modified Glasgow Outcome Scale (m-GOS) one month after operation. RESULTS: UIAs had a high frequency of a middle cerebral artery (MCA) and an internal carotid artery (ICA) aneurysm. Forty-four UIAs (84.6%) ranged between 5 mm to 15 mm in diameter. Fortysix UIAs were treated by clipping, 2 by wrapping, and coil embolization was used in 3 UIAs. In one patient, which had only one UIA, one procedure and one operation was performed. There was no surgical mortality. In most patients, surgical complications or neurological deteriorations were not found. In three patients, minor neurological deficits of ptosis (2 patients) and spinal subdural hematoma (1 patient) were newly developed after operation. However the patients completely recovered within 3 months after operation. Finally, the surgical mortality and morbidity rate was 0%. CONCLUSION: If the UIAs are larger than 5 mm in diameter and located in a susceptible area for rupture, surgical treatment should be considered for the UIAs. If operation is performed by an expert neurosurgeon, surgical clipping is one of the best treatment modalities with or without endovascular treatment.
Aneurysm ; Carotid Artery, Internal ; Embolization, Therapeutic ; Glasgow Outcome Scale ; Hematoma, Subdural, Spinal ; Humans ; Intracranial Aneurysm* ; Medical Records ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Rupture ; Surgical Instruments

A few delayed epistaxis was reported, and it is an unusual complication of closed head injury. We experienced 2 cases of delayed epistaxis and monoocular blindness by cavernous vascular lesions(traumatic aneurysm and C. C. F.). We confirmed the vascular lesions by carotid angiography and Brain C. T. They were treated by carotid ligation and carotid ligation with embolization, and we mer with good results. We present 2 cases of the delayed epistaxis complicated by traumatic lesions of cavernous internal carotid artery, and also the literatures were reviewed.
Aneurysm ; Angiography ; Blindness ; Brain ; Carotid Artery, Internal ; Epistaxis* ; Head Injuries, Closed ; Ligation